Cynthia Wallace, AGPCNP
NPI 1811393648ActiveIndividual· Nurse Practitioner, Gerontology· Medford, OR
Nurse Practitioner, Gerontology (AGPCNP) with Providence Health and Services Oregon, practicing in Medford, Oregon. Medicare paid $22,590 for services to 119 patients in 2024. Lists Providence Medford Medical Center as a hospital affiliation.
Overview
| NPI | 1811393648 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | AGPCNP |
| Sole proprietor | No |
| NPI issued | Nov 5, 2014 |
| Last updated in NPPES | Sep 30, 2020 |
| Certified by provider | Sep 30, 2020 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Nurse Practitioner, Gerontology Primary | 363LG0600X | 201500016NP-PP | OR |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Nurse Practitioner (OR) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 119 |
|---|---|
| Services billed | 486 across 9 procedure codes |
| Paid by Medicare | $22,590 |
Education and affiliations
| Graduation year | 2014 |
|---|---|
| Medicare specialty | Nurse Practitioner |
Medical group
- Providence Health and Services OregonMedford, OR · 19 clinicians
Hospital affiliation
- Providence Medford Medical CenterMedford, OR
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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